Be in the Know!
Balance Billing and why is this important for me to know…
By being a part of our Ambetter from Arizona Complete Health plan, you have the right for all emergency and other authorized covered services to be provided at no additional cost to you other than your copays, coinsurance and deductibles.
We have discovered that some providers may be billing members directly for services above and beyond your share of the cost, a practice known as “balance billing.”
It’s important that you understand your rights and responsibilities as a member. We’re here to provide you with valuable information that can guide you to make more informed decisions when seeking service from your providers.
Your Rights and Responsibilities as a member:
As an Ambetter from Arizona Complete Health member you deserve to get the most out of your health insurance plan. And since we believe that nothing is more important than your health, our Ambetter from Arizona Complete Health insurance plans are designed to fit your health needs and your budget.
But our focus doesn’t stop there. In fact, our commitment to your well-being extends far beyond the doctor’s office and into your everyday life. Ambetter from Arizona Complete Health is active in your local community—and we’re dedicated to helping you live well.
Ambetter from Arizona Complete Health Member Rights and Definitions
Surprise Out-of-Network Bill or Balance Bill:
If you are an Ambetter from Arizona Complete Health member, balance billing does NOT apply to you. As an Ambetter from Arizona Complete Health member you are only subject to certain out-of-pocket cost sharing amounts for covered services such as in the examples provided below in out of pocket costs.
Out of pocket costs:
As an Ambetter from Arizona Complete Health member you are ONLY responsible for paying those copays, coinsurance and deductible (collectively known as “cost sharing”) amounts that apply to you.
- Copay – the amount you pay for a service like an office visit or prescription. These are usually paid at the time of the service.
- Deductible – the amount you need to pay each year for covered services before your plan starts paying for your benefits.
- Coinsurance – the percentage of covered expenses you pay after you meet your deductible.
Example: A visit to the doctor for your sore throat may cost a $25 copay.
Are you unsure about what you owe? Just call us! We’re here to help. Contact Customer Service at 1-888-926-5057.
Explanation of Benefits (EOBs):
What is an EOB and what do you do when you receive it?
- Each time Ambetter from Arizona Complete Health processes a claim submitted by your provider, the Explanation of Benefits lists that claim and how we processed it.
- Your EOB is not a bill.
- The EOB explains the service you received and when, how much was billed, what we paid your provider and any balance you’re responsible for paying the provider. It also tells you how much has been credited toward any required deductible.
- Review your EOB carefully and call us if you have any questions. Contact Customer Service at 1-888-926-5057.
As a member what are your appeals rights?
Where do you file with Arizona Complete Health as an Ambetter from Arizona Complete Health member?
Fill out the Grievance and Appeals form (PDF)
Ambetter from Arizona Complete Health Member Responsibilities
With Ambetter from Arizona Complete Health, you have a wide network of primary care physicians, specialists, hospitals and outpatient facilities to choose from. As a member you can obtain information about available in-network doctors or pharmacies in Arizona or anywhere in the U.S. that is part of your coverage network.
Visit Find a Provider to find your doctor!
We’re here to help you find the healthcare professionals you need. If you don’t find your preferred doctor in the network, please give us a call at 1-888-926-5057. We are always working to contract with the highest quality doctors in the area so your doctor could have been added recently.
As an Ambetter from Arizona Complete Health member, you must visit our in-network service providers for non-emergent covered services such as,
- Pre-natal care
- Well checks
- Scheduled surgery
Everything You Need. Right Here.
With Ambetter from Arizona Complete Health, it's easy to take charge of your health. As an Ambetter member, you have access to the helpful tools and resources you need to manage your plan – all in one place, 24/7 visit the Member Home page for more information.
Customer Service: Do you have questions or concerns about Balance Billing? Were you balanced billed by your provider? We’re here to help, but we need you to hear from you. Our Customer Service Representatives are available to help. Contact Customer Service at 1-888-926-5057.